Gene Laureano, an Army veteran who suffered a spinal cord injury as a result of a ladder fall, stands in the ReWalk exoskeleton while Zoltan Toth has his fourth session at the James J. Peters VA Medical Center. Andrew White/WIRED

This Computerized Exoskeleton Could Help Millions of People Walk Again

Gene Laureano stands in the ReWalk exoskeleton at the James J. Peters VA Medical Center in the Bronx, New York. Andrew White/WIRED

There have been plenty of nights when Gene Laureano didn’t want to wake up. It’s not that he’s depressed, though he has plenty of reason to be. It’s just that he enjoys dreaming. In his dreams, he can walk again.

Laureano, an Army veteran and Bronx native, has been paralyzed from the waist down since 2001, when he fell 20 feet from a ladder while working as a subcontractor on a welding project in Manhattan. “I felt like Wiley Coyote. The ground just fell out from under me,” says Laureano, now 51, on a blazing hot day in June. We’re sitting in the James J. Peters VA Medical Center in the Bronx, where Laureano, dressed in a black T-shirt, jeans, and a U.S. Army baseball cap, is telling me the story of how that day changed his life.

He remembers landing perpendicular across the ladder and passing out as soon as he tried and failed to stand up. When he came to, following a 12-hour surgery, he was lying in a hospital bed, surrounded by his mother, wife, and sister, all of whom were crying. The first thing Laureano felt was a rush of euphoria. “I was like, am I really alive? Is this an out of body experience?” he remembers. But then he noticed the doctor at his feet, busily moving something underneath the blanket that covered his body. It was an instrument studded with needles, and Laureano hadn’t felt a thing. And so it was that the doctor told him he would never walk again.

“At the beginning, you’re like, so I guess this is going to be life,” Laureano says. “But then, after the shock goes by, it’s like: ‘Screw this. There’s got to be more to this.'” And as it turns out, he was right.

‘The day I stood up, I knew I was about to cross the threshold from impossible to possible. It was a moment for me.’

For years, Laureano was hell-bent on finding a way out of his wheelchair. Once he went so far as to hoist himself onto a pair of his neighbor’s crutches, only to crash face-first into an iron gate, knocking out his front teeth. But it wasn’t until 2012 that he found the answer he was looking for. While visiting his doctor at the VA one day in November, he was wheeling himself past the Spinal Cord Damage Research Center, when he saw a contraption he describes as “a robot with sneakers.” It was the ReWalk, a kind of computerized exoskeleton. In January 2013, Laureano joined a clinical trial of the device at the VA, and more than a decade after he was told he would never walk again, he took his first steps. “The day I stood up, I knew I was about to cross the threshold from impossible to possible,” he says. “It was a moment for me.”

Dr. Amit Goffer. ReWalkLaureano owes that moment in large part to a man named Dr. Amit Goffer, founder of the Israeli company Argo Medical Technologies and inventor of the ReWalk. Dr. Goffer, who is quadriplegic himself, knows how devastating being confined to a wheelchair can be. Which is why in 1998, Dr. Goffer, a biomedical engineer by training, began tinkering with an alternative. Since then, so-called ReWalkers have taken Dr. Goffer’s invention to amazing places. In 2012, a paraplegic woman named Claire Lomas completed the London Marathon wearing a ReWalk. The following spring, former U.S. Army Sergeant Theresa Hannigan demonstrated the ReWalk to President Barack Obama during his trip to Jerusalem. And last fall, Laureano and an army of ReWalkers competed in a one-mile race around New York City’s Riverside Park.

But by far the biggest milestone came just a few weeks ago, when the ReWalk became the first and only exoskeleton approved by the FDA for personal use. The ReWalk isn’t the first device of its kind. Other devices like the Ekso and the Indego are currently being used in rehab and research centers around the world, and just last month, a paraplegic man used a mind-controlled exoskeleton developed at Duke University to make the first kick at the World Cup. But the ReWalk is the first device of its kind that paraplegic people in the U.S. can actually buy—albeit for the hefty price of $69,500—using it to walk wherever and whenever they want. For Laureano, it is, quite literally, a dream come true.

An Ugly Prototype

It was one of life’s cruel coincidences that landed Dr. Goffer where he is today. It started in 1997, when his wife received a coupon for a free ATV. “We won,” he tells me by phone with more than a hint of sarcasm. Dr. Goffer was never quite the ATV type, so he decided to sell it, much to his kids’ disappointment. To make it up to them, he agreed to rent some ATVs about 40 minutes from his house.

Dr. Goffer vividly recalls what happened next: the ATV’s brakes failed. His vehicle went crashing into a tree trunk. Dr. Goffer was flung into the tree’s branches, and he snapped his neck on the way down. At the time, he was running a company called Odin Medical Technologies, which made MRI devices for operating rooms. After working on brain imaging technology for so many years, he says he knew what had happened to him as soon as he hit the ground. “My son and the ambulances came over to me,” he remembers. “I told them: ‘Don’t touch me. I’m quadriplegic.'”

Two ReWalks hang on the wall as their batteries recharge. Andrew White/WIRED

He spent the next nine months in the hospital learning how to use a wheelchair and building strength in his muscles. For someone who now has an utterly optimistic view of the future, Dr. Goffer remembers that time as particularly grim. “It was like being in a very big hole in the dark,” he says, all these years later. “When you’re at the bottom such a hole, there’s only one way to go. Up. You can’t get any lower.”

It was only after he left the hospital that Dr. Goffer began to question why people are still using wheelchairs. The modern wheelchair, after all, operates much like those depicted on ancient Chinese vases centuries ago. He wanted to build something drastically different. And so, a small team of Dr. Goffer’s friends and colleagues spent the next six years cobbling together what he lovingly refers to as an “ugly prototype” of the first ReWalk. By 2004, they successfully tested it in Dr. Goffer’s garage with two different subjects, and in 2006, they entered Israel’s famed Technion incubator to further polish the device before sending it off to clinical trials.

The modern wheelchair operates much like those depicted on ancient Chinese vases centuries ago. He wanted to build something drastically different.

But just as important as perfecting the technology was convincing researchers that it works. The exoskeleton has long been a sci-fi fantasy, and according to Dr. Ann Spungen, inventors have been pitching spinal cord injury researchers like herself on their wonky prototypes since the early 90s. Dr. Spungen is associate director of the National Center of Excellence for the Medical Consequences of Spinal Cord Injury at the James J. Peters center. So when Dr. Goffer first came to demonstrate the ReWalk at the center in August 2010, Dr. Spungen was skeptical.

“I saw their guy walking in it, and I’m convinced he’s not really paralyzed because he’s walking so well,” she remembers. She was so skeptical, in fact, that she asked to check the patient’s legs afterward and found that they were, in fact, completely flaccid. She remembers turning to the center’s director, Dr. William Bauman, and saying: “We gotta do this.”

Today, Dr. Spungen is one of the foremost researchers on exoskeleton walking. The center, which currently owns six ReWalks, has gotten 14 paraplegic patients, Laureano included, up and walking. Though Dr. Spungen admits that’s a small sample size, she says the health benefits those 14 patients have experienced from walking in the exoskeleton just a few hours a week are overwhelming. All of them have lost fat. Some have gained muscle. The subjects report better self-images, reductions in pain, better sleep, and, critically, improved bowel function. For paraplegic and quadriplegic people, something as simple as going to the bathroom can be debilitating and highly disruptive to everyday life.

In her 24 years working at the VA and studying what happens to the body after paralysis, Dr. Spungen says exoskeletons are “the biggest intervention we’ve seen yet.”

One Small Step

Laureano is trying not to show off. It’s been more than a year since he took his first steps down the hospital hallway in the ReWalk, and today, in the very same hallway, he maneuvers the clunky device with ease. Zoltan Toth, on the other hand, is having a rough time of it, so Laureano is giving him a head start down the hall. “I don’t want to discourage him and get too far ahead of him,” Laureano tells me quietly.

Trainer Denis Doyle-Green (left) checks the blood pressure of a winded Zoltan Toth after a session with the ReWalk. Andrew White/WIRED

Toth has been paralyzed since May 13, 2011—“the only Friday the 13th in 2011,” he points out—when he fell six stories while working a construction job. Today, the 30-year-old Hungarian native is on his fourth training session with the ReWalk, and he’s still struggling to trust that the legs he can no longer feel will support him. So he’s leaning heavily on a pair of crutches, breaking into a sweat and rubbing his palms raw, as the exoskeleton’s legs lurch his body forward, letting out a robotic squeal with every step. “I started the same way,” Laureano assures Toth. “Don’t get frustrated. If you keep doing it, you’ll start standing up more and more.”

To take a step, he selects the walking mode on the watch and leans forward.

Strapped into the robot, Laureano is standing tall, just the way he likes it. Two motorized leg braces attach to his outer legs. With a black backpack on his back—that’s where the battery is stored—and a pair of crutches in his hands, he looks like a hiker fresh from an REI shopping spree. On his wrist, he wears a large black watch, which acts as a remote control. To take a step, he selects the walking mode on the watch and leans forward. Leaning triggers the ReWalk’s internal sensor to lift a leg. Leaning again, triggers another step, and so on.

Today, Laureano, who is often called upon by Argo for demonstrations, walks at about the same pace at which you might take a leisurely stroll on the beach. Watching him do it is somehow both remarkable and unimpressive. Remarkable because he’s walking. Unimpressive because it appears so natural, it’s easy to forget he can’t walk in the first place.

For Toth and many other beginners, however, it’s not so simple. According to Dr. Spungen, some ReWalkers never master it at all, and even those who can walk well still face substantial obstacles before they can take one of these puppies for a spin around the mall. The nearly $70,000 price tag, for starters, is prohibitively high for many patients, particularly among a population which the World Health Organization estimates has an unemployment rate of around 60 percent. Dr. Spungen says many of her patients have started holding fundraisers to buy their own.

One Giant Leap Ahead

But now that the ReWalk has FDA approval, says Argo CEO Larry Jasinski, who joined the company in 2012 after spending his career in the medical device industry, it will be easier to convince insurers to cover it. By making paraplegic people healthier, he argues, exoskeletons like the ReWalk may actually save insurers money. According to a 2007 study by the National Institute of Health, the average direct healthcare cost for victims of spinal cord injury is $21,450 a year.

By reducing the amount of medication people take and the frequency of hospitalization, the ReWalk could significantly reduce healthcare costs longterm. “If you’ve had your leg amputated above the knee, is there debate about whether you need a prosthetic? There really isn’t,” he says. “We think this will have a more favorable reimbursement path over time. Our responsibility now is to get the data.”

But Dr. Spungen warns that even for patients who can pay for the device out-of-pocket—several have already done so in just the first few weeks—the ReWalk won’t be a wheelchair killer. The average ReWalker in her center walks around one mile per hour. Most of us walk at 3 miles per hour, meaning a motorized wheelchair is still much more efficient. The device, which weighs about 50 pounds, is still too heavy to go much faster than that, because with too much momentum, it could make it dangerous to come to a sudden stop. “They have to improve the device a little more before they can increase the speed,” she says.

‘If you’ve had your leg amputated above the knee, is there debate about whether you need a prosthetic? There really isn’t.’

When I ask Laureano what improvements he’d like to see, his mind goes blank. “It’s a hard question, because, does it get any better?” he says. “Who knows, maybe if I own one, I’ll start nitpicking, even though I’m not that type of person, but right now, I’ll take it just the way it is.”

Still, perhaps the biggest hurdle Argo has to overcome is the fact that quadriplegic people still can’t use the ReWalk, because they can’t use their arms to control the crutches, which are vital to retaining balance. That means that Dr. Goffer, the very man who has effectively given people like Laureano their legs back, is still in a wheelchair. You could be forgiven for seeing the tragedy in that, but Dr. Goffer insists he doesn’t dwell on that fact. “You have to understand the great impact on the families of people using the device, the VA soldiers crying on my shoulder from happiness,” he says. “The reward is so great, I can’t even think about my own situation.”

That said, Argo is now working on a device that even quadriplegic people, or people suffering from other debilitating diseases like multiple sclerosis, could use. “My time will come,” Dr. Goffer says. “I’m patient enough for that.”